Provider Demographics
NPI:1508834441
Name:CRUTE, CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CRUTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SEWALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2643
Mailing Address - Country:US
Mailing Address - Phone:207-772-8823
Mailing Address - Fax:207-772-1856
Practice Address - Street 1:51 SEWALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2643
Practice Address - Country:US
Practice Address - Phone:207-772-8823
Practice Address - Fax:207-772-1856
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME8892325OtherCIGNA OFFICE ID #
MEM188110OtherCIGNA PROVIDER ID
ME2449295OtherAETNA OFFICE ID #
ME099071OtherANTHEM OFFICE ID #
MEB86348OtherHARVARD PILGRIM ID #
ME040814OtherANTHEM PROVIDER ID
ME2367189OtherAETNA PROVIDER ID
MEB86348OtherHARVARD PILGRIM ID #
MEMM0538Medicare ID - Type Unspecified